Dengue vaccination in Canada
Diana Zhong, MD1, Anna P. Durbin, MD2
- Infectious Diseases Fellow Division of Infectious Diseases, Johns Hopkins School of Medicine
- Professor, International Health and Director, Center for Immunization Research John Hopkins Bloomberg School of Public Health
Dengue is caused by the mosquito-borne dengue virus (DENV), of which there are four serotypes (DENV-1, DENV-2, DENV-3, DENV-4). Each of the 4 DENV types can cause a full spectrum of illness which ranges from a mild flu-like illness to a severe and life-threatening vascular leak syndrome (<5% of cases). Dengue is endemic in tropical and sub-tropical regions with approximately 6 billion people thought to be at risk for dengue. No Canadian provinces are known to have endemic dengue infection—meaning that dengue does not occur frequently or continuously within Canada. There are approximately 200-300 cases of dengue in Canada annually, which are all from returning travelers.
Globally, there is only one approved vaccine against dengue, Dengvaxia (CYD-TDV), which is manufactured by Sanofi Pasteur. The vaccine is tetravalent, meaning that it covers four different types of dengue virus. Dengvaxia is live attenuated, meaning that the vaccine is made from a weakened form of the dengue virus. The vaccine is recombinant, meaning that the weakened dengue virus used in the vaccine is genetically combined with another vaccine virus, in this case the yellow fever vaccine virus. The World Health Organization recommends Dengvaxia for persons 9-45 years of age living in dengue-endemic areas who have previously had a documented dengue infection. This recommendation is based on concerns that the vaccine may worsen the severity of dengue illness in individuals who have not previously had dengue infection. The vaccine is given as a three-dose vaccine series with each dose given 6 months apart.
Dengue vaccination is not currently available in Canada. The vaccine is not recommended for routine vaccination of Canadian residents and is currently not approved for Canadian travelers to other countries. The vaccine is licensed in 20 countries for children and adolescents who are living in dengue-endemic areas with laboratory confirmation of previous dengue infection.
There are two other dengue vaccines (DENVax from Takeda; TV003/TV005 from the National Institute of Allergy and Infectious Diseases and Butantan Institute) completing phase III clinical trials and may be available for licensure in the future.
- Government of Canada [Internet]. Dengue fever; 2014 [cited 2023Mar14]. Available from: https://www.canada.ca/en/public-health/services/infectious-diseases/viral-haemorrhagic-fevers/dengue-fever.html
- World Health Organization [Internet]. Vaccines and immunization: Dengue; 2018 [cited 2023Mar14]. Available from: https://www.who.int/news-room/questions-and-answers/item/dengue-vaccines
- World Health Organization [Internet]. Safety of CYD-TDV dengue vaccine; 2015 [cited 2023Mar14]. Available from: https://www.who.int/groups/global-advisory-committee-on-vaccine-safety/topics/dengue-vaccines/cyd-tdv